Towards a national health insurance system in ... - Detlef Schwefel

Towards a national health insurance system in Yemen – Part 1: Background and assessments 29
Table 13
Empowerment in security creates opportunities
What For whom Why Topic Agent
to prevent avoidable Health education and
Health
diseases
promotion
of individuals
to apply informed self-help, Drug accessibility,
and
Health
e.g. with drugs
affordability
families
to fight for good
Capacity building
Education
governance, wherever
of civil groups
to support families and Discovery and
neighbourhoods
inclusion
Education
Empowerment
to work in the public Effectiveness,
subsidiarity)
interest
efficiency mgt
Education
of local to do what families /groups Public health, out and
governments can not do
inpatient care
Health
to support those who can
not support themselves
Social protection
Health
to regulate in the public Regulation,
of national interest
supervision
Civil society
government to do what other levels can Tertiary care,
not do
reassurance funds
Health
with quality to deliver services of high Good service delivery,
health care quality
wherever
Health
with social
Social protection
to help the helpless
protection
measures
Health
in security
with
insurances
to pool high risks Social health insurance Health
(solidarity)
to avoid man-made
with policies
catastrophes, e.g. wars
Wider health policy
Health
with disaster to mitigate other
preparedness catastrophes
Wider health policy
Health
and other
measures
to sustain peace Wider health policy Civil society
economic through “macroeconomics / At the micro-economic
growth health link”
level, too
Development
creates
social through increased
Bottom-up capacity
opportunities development participation
building
Development
(sustainability)
political
commitment
through reinforcement of
democracy and
accountability
Empowering a civil
society
Development
3.2 Health Sector
3.2.1. Health status
Yemen faces major challenges in improving the health status of its population. The basic social and
economic determinants of health are in a dire state: poverty is widespread, participation in primary
education is low, in particular for girls, illiteracy rates are high, and access to safe drinking water and
proper sanitation is very limited. With 42% of the population living under the absolute poverty line of
US$1 per capita per day, Yemen is the country with the highest national poverty rate in the MENA
region, where the average of people living in absolute poverty lies at 2.8% (World Bank 2004). Only
28.5% of women and 69.5% of men can read (World Bank 2005b), and only 48% of girls and 66% of
boys complete primary school. Only 9.6% of the rural population has access to safe drinking water
compared to 52.4% of the urban population (MoPH&P 2005a).